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1.
2.

Objective

To synthesize experiences of the patient complaints process for patients and health‐care professionals to identify facilitators and barriers in the successful implementation of patient complaints processes. This will assist the development of cultural change programmes, enabling complaints managers to incorporate stakeholder perspectives into future care.

Design

Systematic literature search and meta‐ethnography, comprising reciprocal syntheses of “patient” and “professional” qualitative studies, combined to form a “line‐of‐argument” embodying both perspectives.

Data sources

MEDLINE, CINAHL and PsycINFO (database inception to April 2015) were searched to identify international literature in primary and secondary health‐care settings, involving qualitative data collection and analysis. Further studies were identified from hand‐searching relevant journals, contacting authors, article reference lists and Google Scholar.

Results

A total of 13 papers, reporting 9 studies from the United Kingdom, Sweden, Australia and New Zealand, were included in the synthesis. Facilitators and barriers to the successful implementation of patient complaints processes were identified across the perspectives of both patients and health‐care professionals. Patients sought to individualize the complaints process by targeting specific professionals who engaged in practices that undermined the identity of patients. In contrast, professionals obscured their own individualism through maintaining a collective identity and withholding personal judgement in relation to patient complaints.

Conclusions

Complainants recognized health‐care professionals as bearers of individual accountability for unsatisfactory care, in opposition to the stance of collective responsibility endorsed by professionals. Implementation of patient complaints processes must reconcile the need for individualized resolution, whilst striving to improve the future provision of health care through a collaborative approach between patients and professionals.  相似文献   

3.

Background

Health literacy describes the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health. Suboptimal health literacy is common and is believed to impact up to 60% of Australians. Co-design is a participatory approach to the development of interventions that brings together to staff and patients to design local solutions to local problems. The aim of this study is to describe a staff and patient co-design process that will lead to the development of health literacy interventions in response to identified health literacy needs of hospital patients.

Methods

A mixed methods, two-step sequential explanatory design. Step 1: hospitalised patients surveyed and data analysed using hierarchical cluster analysis to establish health literacy profiles. Step 2: clusters presented as vignettes to patients and clinicians to co-design interventions to address needs.

Results

Eight health literacy clusters were identified from surveys. Seven patients attended two patient workshops and 23 staff attended two staff workshops. Three key themes were identified: organisational, provider-patient, and patient self-care. Within these, five sub-themes emerged: “Good quality communication during hospital stay”, “Social support for health”, “A good discharge”, “Care across the continuum” and “Accessing quality information when home”. Fifteen potential interventions were produced, including changes to message design and delivery, staff training in assessing for understanding, social support to improve understanding, improving communication consistency across the care continuum, and strategic dissemination of web-based resources.

Conclusion

This study identified fifteen strategies to address health literacy needs of a hospital population. Implementation and evaluation will identify sets of strategies that have the maximum patient, clinician and organisational benefit. This approach allows for the development of locally-driven, contextually-appropriate interventions to address health literacy needs.
  相似文献   

4.
5.

Issue addressed

Social marketing (SM) campaigns can be a powerful disease prevention and health promotion strategy but health‐related campaigns may simply focus on the “promotions” communication activities and exclude other key characteristics of the SM approach. This paper describes the application of a checklist for identifying which lifestyle‐related chronic disease prevention campaigns reported as SM actually represent key SM principles and practice.

Methods

A checklist of SM criteria was developed, reviewed and refined by SM and mass media campaign experts. Papers identified in searches for “social marketing” and “mass media” for obesity, diet and physical activity campaigns in the health literature were classified using the checklist.

Results

Using the checklist, 66.6% of papers identified in the “SM” search and 39% of papers identified from the “mass media” search were classified as SM campaigns. Inter‐rater agreement for classification using the abstract only was 92.1%.

Conclusions

Health‐related campaigns that self‐identify as “social marketing” or “mass media” may not include the key characteristics of a SM approach. Published literature can provide useful guidance for developing and evaluating health‐related SM campaigns, but health promotion professionals need to be able to identify what actually comprises SM in practice.

So what?

SM could be a valuable strategy in comprehensive health promotion interventions, but it is often difficult for non‐experts to identify published campaigns that represent a true SM approach. This paper describes the application of a checklist to assist policy makers and practitioners in appraising evidence from campaigns reflecting actual SM in practice. The checklist could also guide reporting on SM campaigns.
  相似文献   

6.

Background

Youth mentoring programs rely largely on volunteers, but youth facing significant risks may be poor candidates for volunteer-based interventions. Full-time “professional” mentors in highly structured programs may be better suited to partner effectively with such youth and their families, but few studies examine professional mentoring interventions. Because of mentoring’s inherent flexibility, mentors’ role conceptualizations can profoundly influence the nature of their work. Serving as a professional mentor may have important implications for how mentors conceptualize and perform their role.

Objective

This qualitative study examined the role conceptions of professional mentors serving at-risk youth.

Methods

Semi-structured interviews with mentors were transcribed, coded, and subjected to thematic analysis.

Results

Mentors described the importance of “professionalism” in prioritizing mentoring, expending considerable effort, and performing difficult or unpleasant tasks. They reported that serving multiple children full-time enabled them to rapidly build expertise, that credibility and authority granted them because of their professional status facilitated their work across multiple key contexts, and that their expertise and long-term commitment facilitated the development of deep relationships. Mentors perceived their role as highly challenging but reported high self-efficacy. They described high multifaceted organizational support, a community for youth, and an individualized child focus.

Conclusions

A mentoring model delivered by experienced professional mentors may hold promise for working with youth at high risk. The role conceptualizations of mentors and the organizational culture within which mentors work may be important in helping youth succeed.  相似文献   

7.

Objective

To identify and describe the standardized interconception and preconception screening tools for reproductive health needs that are applicable in general outpatient clinical practice.

Data Sources and Study Setting

This systematic review identifies research on pregnancy intention screening and counseling tools, and standardized approaches to preconception and interconception care. We focus on tools designed for clinical settings, but also include research tools with potential for clinical implementation. These tools may include a component of contraceptive counseling, but those focusing solely on contraceptive counseling were excluded. Data were collected from studies done in the United States between January 2000 and March 2022.

Study Design

We performed a systematic literature search to generate a list of unique tools, assessed the quality of evidence supporting each tool, and described the peer-reviewed clinical applications of each. We used the Mixed Methods Appraisal Tool to appraise the quality of individual studies.

Data Collection/Extraction Methods

We searched PubMed, Web of Science, and CINAHL databases for standardized preconception and interconception health screening tools published in English from January 2000 through March 2022. We used keywords “preconception care,” “interconception care,” “family planning,” “contraception,” “reproductive health services,” and “counseling.” Utilizing the Preferred Reporting Items for Systematic Reviews guidelines, we screened titles and abstracts to identify studies for full text review.

Principal Findings

The search resulted in 15,399 studies. After removing 4172 duplicates, we screened 11,227 titles/abstracts and advanced 207 for full-text review. From these, we identified 53 eligible studies representing 22 tools/standardized approaches, of which 10 had evidence from randomized clinical trials. These ranged widely in design, setting, and population of study.

Conclusions

Clinicians have a choice of tools when implementing standard reproductive screening services. A growing body of research can inform the selection of an appropriate tool, and more study is needed to establish effects on long-term patient outcomes.  相似文献   

8.

Objective and method

An increased percentage of German schoolteachers suffers from psychosomatic symptoms. In 2002/2003 a federation of Bavarian schoolteachers conducted 1-day health retreats for teachers. Socio-demographic data, subjective levels of workload, burn-out and motivation to change individual health behaviour (transtheoretical model) were recorded.

Results

Two-thirds of 639 participants reported elevated severe occupational stress, and about 20% felt “burn-out”; 40% fulfilled the criteria for an early stage of motivation (“preparation”) and less than 20% a more advanced motivational stage (“action”).

Conclusion

In terms of changes in health behaviour, 1-day health retreats for teachers attracted an interested (70%) but little advanced target group. The results suggest that specific preventive interventions be tailored to individual stress experiences and motivational stages. Content-related, methodological and political implications are discussed.  相似文献   

9.

Objective

Most evidence‐based body image programs for college students (e.g., the Body Project) are designed for female‐only audiences, although body dissatisfaction is not limited to female‐identified individuals. Furthermore, programs do not explicitly discuss diversity, although individuals with marginalized gender, racial, and sexual identities may be particularly vulnerable to body image disturbances. Making programs more inclusive may increase their disseminability.

Method

This qualitative study examined the feasibility of adapting the Body Project for universal and inclusive use with college students. Participants (N = 36; M age = 21.66 years; 73% female‐identified; 20% sexual minority; 23% racial minority) attended one of five semi‐structured focus groups to explore the inclusivity of appearance‐based cultural norms using adapted Body Project activities and discuss the feasibility of universal and inclusive interventions. Inductive qualitative content analysis with three‐rater consensus identified focus group themes.

Results

There was consensus that inclusive interventions could have a positive impact (broadening perspectives, normalizing body image concerns, increasing awareness) despite potential barriers (poor diversity representation, vulnerability). There was strong consensus regarding advice for facilitating inclusive interventions (e.g., skilled facilitation, education, increasing diversity).

Discussion

Results suggest that inclusive body image programs are desirable and provide a framework for creating the EVERYbody Project, a program for more universal audiences.  相似文献   

10.

Background

UK Hospital Trusts are charged with increasing patients’ research awareness and willingness to take part in research. This includes implementing strategies to encourage patient‐initiated enquiries about participation.

Objectives

To evaluate the impact of a research statement inserted in outpatient letters in one clinical service, and to derive suggestions on potential steps towards increasing patient‐initiated recruitment.

Setting

A medical outpatient clinic of a research‐active hospital trust, serving an inner‐city multi‐ethnic population across two boroughs.

Methods

Pre‐intervention and post‐intervention questionnaires were administered face‐to‐face to new patients. Questionnaires included closed questions and one open comments section. Data were analysed for frequencies, with thematic coding of open‐ended responses.

Results

The response rates were 87% for the pre‐intervention survey and 92% for the post‐intervention survey. In the post‐intervention survey, 85% of patients did not notice the research statement in the letter. More than half found the statement “a little unclear,” whilst one‐third considered it “clear.” Three‐quarters of respondents perceived the statement to be “a little helpful.” Only one person enquired about participating in clinical research having read the statement in the outpatient letter.

Conclusion

The analysis suggests that simple, single‐solution approaches such as including research statements in outpatient letters are unlikely to be sufficient to significantly facilitate patient‐initiated recruitment. Recruitment efforts need to take into consideration the diversity of patient constituencies including the reasons they seek health care, and how patients can meaningfully access information (research literacy).  相似文献   

11.

BACKGROUND

Using Social Cognitive Theory as a framework, we examined opportunities for promoting local produce consumption among high school students in a lower‐income, ethnically diverse, urban community.

METHODS

Six focus groups (N = 53) were conducted with students. Using Atlas.ti qualitative software, data were coded and reviewed to identify code categories which could be taken to represent themes.

RESULTS

Students (56.8% girls, 86.5% nonwhite) described local produce as being grown “nearby” or “in Connecticut.” Overwhelmingly, students perceived local produce to be of higher quality (eg, “tastes better,” “fresher”) than nonlocal produce. Students reported that the foods served at school are “unnatural” and “made in a factory.” Salient perceived outcomes associated with consuming local produce included “benefits the environment,” “builds community and trust,” and “keeps taxes down.” Students recommended hanging large colorful posters highlighting the positive outcomes associated with consuming local produce in school locations with captive audiences such as lunch lines and classrooms. Labels identifying the food origins of cafeteria foods provided as well as taste tests of local produce might support students' self‐efficacy for consuming local fruits and vegetables.

CONCLUSIONS

These findings provide theory‐based strategies for how to promote local produce consumption among a diverse group of urban high schools students.
  相似文献   

12.
ObjectiveTo compare the contribution of “trial-sibling” and “unrelated” qualitative studies in complex intervention reviews.Study Design and SettingResearchers are using qualitative “trial-sibling” studies undertaken alongside trials to provide explanations to understand complex interventions. In the absence of qualitative “trial-sibling” studies, it is not known if qualitative studies “unrelated” to trials are helpful. Trials, “trial-sibling,” and “unrelated” qualitative studies looking at three health system interventions were identified. We looked for similarities and differences between the two types of qualitative studies, such as participants, intervention delivery, context, study quality and reporting, and contribution to understanding trial results.ResultsReporting was generally poor in both qualitative study types. We detected no substantial differences in participant characteristics. Interventions in qualitative “trial-sibling” studies were delivered using standardized protocols, whereas interventions in “unrelated” qualitative studies were delivered in routine care. Qualitative “trial-sibling” studies alone provided insufficient data to develop meaningful transferrable explanations beyond the trial context, and their limited focus on immediate implementation did not address all phenomena of interest. Together, “trial-sibling” and “unrelated” qualitative studies provided larger, richer data sets across contexts to better understand the phenomena of interest.ConclusionsFindings support inclusion of “trial-sibling” and “unrelated” qualitative studies to explore complexity in complex intervention reviews.  相似文献   

13.
Abstract

Objective: Lengthy sick leave makes demands on work ability enhancing interventions in primary health care. Problem-based method (PBM) and cognitive behavioural therapy (CBT) are interventions aimed at people with common mental disorders. This study aimed to describe how individuals experienced interventions and the impact the interventions had on the individuals' ability to work and perform other everyday activities. Method: Fourteen women and two men, eight each from two interventions, were interviewed. The interviews were analysed using qualitative content analysis. Results: The analysis revealed one overarching theme: “Reaching safe ground or continuing to seek help”. Four categories were identified: “From being passive to making one's own efforts in the rehabilitation process”, “Being stuck on a treadmill or daring to change”, “Evolving from routine to more aware behaviour”, and “Fitting in or not fitting in with workplace situations”. Conclusions: According to the participants, experiences from both PBM and CBT had a positive impact on their ability to work and perform other everyday activities in a more sustainable way. Reflecting on behaviour and achieving limiting strategies were perceived as helpful in both interventions, although varying abilities to incorporate strategies were described. In general, the results support the use of active coping-developing interventions rather than passive treatments.  相似文献   

14.

Background

Globally, health‐care systems and organizations are looking to improve health system performance through the implementation of a person‐centred care (PCC) model. While numerous conceptual frameworks for PCC exist, a gap remains in practical guidance on PCC implementation.

Methods

Based on a narrative review of the PCC literature, a generic conceptual framework was developed in collaboration with a patient partner, which synthesizes evidence, recommendations and best practice from existing frameworks and implementation case studies. The Donabedian model for health‐care improvement was used to classify PCC domains into the categories of “Structure,” “Process” and “Outcome” for health‐care quality improvement.

Discussion

The framework emphasizes the structural domain, which relates to the health‐care system or context in which care is delivered, providing the foundation for PCC, and influencing the processes and outcomes of care. Structural domains identified include: the creation of a PCC culture across the continuum of care; co‐designing educational programs, as well as health promotion and prevention programs with patients; providing a supportive and accommodating environment; and developing and integrating structures to support health information technology and to measure and monitor PCC performance. Process domains describe the importance of cultivating communication and respectful and compassionate care; engaging patients in managing their care; and integration of care. Outcome domains identified include: access to care and Patient‐Reported Outcomes.

Conclusion

This conceptual framework provides a step‐wise roadmap to guide health‐care systems and organizations in the provision PCC across various health‐care sectors.  相似文献   

15.
16.

Background

In medical practice, obtaining information regarding patients’ undisclosed “feelings of anxiety” or “depressive feelings” is important. The purpose of this study was to determine which interview skills are best suited for eliciting verbal indications of undisclosed feelings, for example anxiety or depressive feelings in patients.

Methods

Our group videotaped 159 medical interviews at an outpatient department of the Department of Family Medicine, Mie University Hospital (Mie, Japan). Physicians’ medical interview skills were evaluated using a Medical Interview Evaluation System and Emotional Information Check Sheet for assessing indications of “feelings of anxiety” or “depressive feelings”. We analyzed the relationship between the interview skills and patients’ consequent emotional disclosure using generalized linear model (GLIM).

Results

The usage of interview skills such as “open-ended questions” “asking the patient’s ideas about the meaning of illness” “reflection” and “legitimization” were positively associated with the number of anxiety disclosure, whereas “close-ended questions” and “focused question” were negatively associated. On the other hand, only “respect” was positively associated with the number of depressive disclosures, whereas “surveying question” was negatively associated.

Conclusions

The results revealed that there are several interview skills that are effective in eliciting verbal indication of undisclosed “feelings of anxiety” or “depressive feelings”.
  相似文献   

17.

Background

The United Kingdom has been at the forefront of enhancing pharmacist roles and community pharmacy services, particularly over the past decade. However, patient and public awareness of community pharmacy services has been limited.

Objective

To identify and synthesize the research literature pertaining to patient and public perspectives on: existing community pharmacy services, extended pharmacist roles and strategies to raise awareness of community pharmacy services.

Search strategy

Systematic search of 8 electronic databases; hand searching of relevant journals, reference lists and conference proceedings.

Inclusion criteria

UK studies investigating patient or public views on community pharmacy services or pharmacist roles from 2005 to 2016.

Data extraction and synthesis

Data were extracted into a grid and subjected to narrative synthesis following thematic analysis.

Main results

From the 3260 unique papers identified, 30 studies were included. Manual searching identified 4 additional studies. Designs using questionnaires (n = 14, 41%), semi‐structured interviews (n = 8, 24%) and focus groups (n = 6, 18%) made up the greatest proportion of studies. Most of the studies (n = 28, 82%) were published from 2010 onwards and covered perceptions of specific community pharmacy services (n = 31). Using a critical appraisal checklist, the overall quality of studies was deemed acceptable. Findings were grouped into 2 main themes “public cognizance” and “attitudes towards services” each with 4 subthemes.

Discussion and conclusions

Patients and the public appeared to view services as beneficial. Successful integration of extended pharmacy services requires pharmacists’ clinical skills to be recognized by patients and physicians. Future research should explore different approaches to increase awareness.  相似文献   

18.

Introduction

Digital delivery of pre-operative total knee replacement (TKR) education and prehabilitation could improve patient outcomes pre- and post-operatively. Rigorously developing digital interventions is vital to help ensure they achieve their intended outcomes whilst mitigating their potential drawbacks.

Objective

To develop a pre-operative TKR education and prehabilitation digital intervention, the ‘Virtual Knee School’ (VKS).

Methods

The VKS was developed using an evidence-, theory- and person-based approach. This involved a mixed methods design with four phases. The first three focused on planning the VKS. The final phase involved creating a VKS prototype and iteratively refining it through concurrent think-aloud interviews with nine patients who were awaiting/had undergone TKR. Meta-inferences were generated by integrating findings from all the phases. ISRCTN registration of the overall project was obtained on 24 April 2020 (ISRCTN11759773).

Results

Most participants found the VKS prototype acceptable overall and considered it a valuable resource. Conversely, a minority of participants felt the prototype's digital format or content did not meet their individual needs. Participants' feedback was used to refine the prototype's information architecture, design and content. Two meta-inferences were generated and recommend:
  • 1. Comprehensive pre-operative TKR education and prehabilitation support should be rapidly accessible in digital and non-digital formats.
  • 2. Pre-operative TKR digital interventions should employ computer- and self-tailoring to account for patients' individual needs and preferences.
  相似文献   

19.

Background

Colorectal cancer (CRC) screening programmes using a guaiac faecal occult blood test (gFOBt) reduce CRC mortality. Interval cancers are diagnosed between screening rounds: reassurance from a negative gFOBt has the potential to influence the pathway to diagnosis of an interval colorectal cancer.

Methods

Twenty‐six semi‐structured face‐to‐face interviews were carried out in Scotland and England, with individuals diagnosed with an interval colorectal cancer following a negative gFOBt result.

Results

Participants reported they were reassured by a negative gFOBt, interpreting their result as an “all clear”. Therefore, most did not suspect cancer as a possible cause of symptoms and many did not recall their screening result during symptom appraisal. Among those who did consider cancer, and did think about their screening test result, reassurance from a negative gFOBt led some to “downplay” the seriousness of their symptoms with some interviewees explicitly stating that their negative test result contributed to a delayed decision to seek help.

Conclusion

Screening participants need to be informed of the limitations of screening and the ongoing risk of developing colorectal cancer even when in receipt of a negative result: the importance of minimizing delay in seeking medical advice for colorectal symptoms should be emphasized.  相似文献   

20.

Objective

To explore parental decision making following diagnosis of a severe congenital anomaly, and implications for healthcare encounters.

Design

Qualitative semi‐structured interviews with 38 parents‐to‐be were collated and triangulated with data generated from consultation recordings.

Analysis

Data were analysed using a constant comparative‐based approach.

Setting

Recruitment was undertaken across four fetal medicine sites in two tertiary referral trusts.

Participants

Parents‐to‐be whose pregnancy was suspected or diagnosed as being affected by a severe congenital anomaly. This sample was purposive to include known factors affecting the decision to terminate or continue the affected pregnancy.

Findings

In trying to make a decision about how to proceed with their pregnancy, parents‐to‐be typically had to work hard to negotiate multiple uncertainties around the diagnosis and prognosis of the suspected anomaly. This was influenced by parents’ capacity to cope with uncertainty and the way in which uncertainty was managed by the clinical team. This negotiation of uncertainty was enacted within a fluid, nonlinear three‐phase process: “information seeking,” reflecting the way parents‐to‐be face the uncertainty associated with a fetal diagnosis and associated prognosis; “implications,” where consideration is given to future consequences of the decision; and “decision making,” which reflects the way in which the decision is made (head‐ or heart‐led). Spectrums of responses were apparent within each phase.

Conclusions

This study provides important insights into how parents‐to‐be make decisions following diagnosis or suspicion of a severe congenital anomaly. The impact of these on healthcare encounters is discussed, alongside recommendations for clinical practice.  相似文献   

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